The Road goes ever on and on ... Day 493 (993)

Most of what i'll share today comes from one source but one I count as very credible, Eric Topol of the Scripps Institute. Much of the late morning and early afternoon was spent getting ready for and at a meeting of our Homeowners Association. There were 16 people seated around a large dining table. I was the only person wearing a mask. The neighbor who sat down beside me asked if masks were required; I thought that was funny given that only one person had one on. I told him they were optional. He did not pull one out of a pocket to wear.

I'm not giving up my mask any time soon. It's not looking at all good out there. Hospitalizations are up 25 percent. ICU admissions, test positivity, wastewater surveillance virus levels, and new cases are also rising. Cases continue to be undercounted due to home testing. Seniors (this sounds so much more polite than "elderly" to me) continue to bear the brunt of it. An analysis by the CDC and Kaiser Family Foundation shows that with most seniors having had the first two shots, more deaths are among those who have not added a booster to the initial doses.

More than one factor is in play here. Immunity is waning in no small part due to the pathetic booster rate. The US ranks lower than 70th among nations of the world. Less than one-third of seniors have gotten the bivalent booster. Having had a booster in the past four to six months does not do much to block infections, but it does a good job at preventing serious disease and hospitalization. Vaccinations have been available for almost two years now, and the CDC is still calling that "fully vaccinated." Boosters do not count toward the "fully."

Few mitigation measures still matter. The weather is turning cold, and people are turning to indoor gatherings for the holidays. My being the only masked person of 16 is not unusual. I haven't read anything about air filtration or ventilation lately. I am reminded of the childish "if I can't see you, you can't see me." Ignoring, not seeing, COVID does not mean it is no longer out there.

Omicron's BA.5 variant now accounts for only 14 percent of new cases in the US. BQ.1 and BQ.1.1 now account for almost 63 percent of new cases. The major difference between the two BQ variants is that BQ.1.1 is more immune evasive and resistant to Evusheld. Both are resistant to Bebtelovimab which is why the FDA has withdrawn its Emergency Use Authorization. This means that we have lost the most preventive measure for immunocompromised people, Evusheld. There is no replacement on the horizon. The prevalence of BQ.1 was dropping in France, but is no longer. Hospitalizations have risen as BQ.1.1 has become more dominant. France now has the highest hospital admissions per capita. It's worth noting here that the French booster rate is 50 percent higher than ours. Finally, Paxlovid remains underprescribed for seniors despite its reducing severity and hospitalizations as well as long COVID.

A new wave is sweeping across Asia with cases rising in Japan, Australia, Hong Kong, and South Korea. Japan is seeing the beginning of a second BA.5 wave. They have done a great job of dealing with COVID but still have 120,000 new cases daily. Cases rising in Australia and New Zealand not to mention South America suggests that cold weather is not the large factor some would like to think. 

How do we handle all this? Getting more bivalent booster doses into people, especially seniors, is one way. Ideally, everyone over the age of 50 would get the booster, but I think we know that that isn't going to happen. Can we re-introduce some of the mitigation measures we've dropped? Masks, anyone? Not gonna work unfortunately. We need to work harder toward a pan-coronavirus vaccine or we can abandon hope of yearly boosters. A pan-influenza vaccine seems effective; why not one for coronaviruses as well?

As we ponder all this, we should note that tomorrow is the start of National Influenza Vaccination Week.